Surgical tactics with acute pancreatitis complicated ascites-peritonitis

Authors

  • V. V. Kasian Ukrainian Medical Stomatological Academy, Poltava, Ukraine,
  • O. Yu. Cherkun Ukrainian Medical Stomatological Academy, Poltava, Ukraine,
  • D. A. Sytnik Ukrainian Medical Stomatological Academy, Poltava, Ukraine,
  • V. D. Sheiko Ukrainian Medical Stomatological Academy, Poltava, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2019.4.173353

Keywords:

pancreatitis, ascites, peritonitis, drainage, peritoneal

Abstract

Fluid accumulation in the peri-pancreatic region and the distal areas of the abdominal cavity is widespread in the early stage of acute severe pancreatitis. The fluid is mainly hemorrhagic ascites, rich in activated lipolytic and proteolytic enzymes, vasoactive substances and inflammatory cytokines, and is aseptic at the onset of the disease. Evacuation of a fluid rich in potentially toxic mediators from the abdominal cavity is supported in a number of publications as a rational measure to alleviate the burden of disease in critically ill patients.

The purpose of the study was to analyze recent publications on surgical tactics for enzymatic peritonitis and its impact on acute severe pancreatitis. A thorough analysis of the literature made it possible to draw the following conclusions related to the state of this problem. To date, randomized clinical trials and publications show controversial data on the efficacy of surgical interventions for acute pancreatitis complicated by ascites-peritonitis. International recommendations have a low level of evidence regarding the effectiveness of drainage, lavage and video-laparoscopic rehabilitation due to inclusion of patients with non-severe pancreatitis into individual studies. Optimization of surgical tactics in patients with ascites-peritonitis in severe pancreatitis may be associated with the definition of: the severity of the condition in patient with ascites-peritonitis, parapancreatitis severity, toxicity level of ascites-peritonitis, indications and optimal drainage / lavage time. To address these issues, there is a need for further prospective studies.

 

 

References

  1. Lobanova, O. M. (2010). Ultrazvukova nekrektomiia v khirurhichnomu likuvanni khvorykh na infikovanyi nekrotychnyi pankreatyt (Avtoref. dis…kand. med. nauk). [Ultrasonic necrectomy in surgical treatment of patients with infected necrotic pancreatitis]. (Extended abstract of candidate’s thesis). Kyiv. [in Ukrainian].
  2. Mishalov, V. G., Markulan, L. Yu., & Matveyev, R. M. (2015). Rezultaty likuvannia patsiientiv z hostrym pankreatytom [Treatment results of patients with acute pancreatitis]. Khirurhiia Ukrainy, 1, 84–89. [in Ukrainian].
  3. Cherkun, O. Yu., Kasyan, V. V., Kalyuzhka, A. S., & Sheiko, V. D. (2017). Prohnozuvannia etapnykh khirurhichnykh vtruchan pry infektsiino-septychnykh uskladnenniakh destruktyvnoho pankreatytu [Prediction of staged surgical interventions in septic complications of destructive pancreatitis]. Aktualni problemy suchasnoi medytsyny,17(3), 315–318. [in Ukrainian].
  4. Andersson, B., Appelgren, B., Sjödin, V., Ansari, D., Nilsson, J., Persson, U., et al. (2013). Acute pancreatitis – costs for healthcare and loss of production. Scandinavian Journal of Gastroenterology, 48(12), 1459–65. doi: 10.3109/00365521.2013.843201
  5. Caronna, R., Benedetti, M., Morelli, A., Rocco, M., Diana, L., Prezioso, G., et al. (2009). Clinical effects of laparotomy with perioperative continuous peritoneal lavage and postoperative hemofiltration in patients with severe acute pancreatitis. World Journal of Emergency Surgery, 4, 45. doi: 10.1186/1749-7922-4-45
  6. De Waele, J. J., Hoste, E., Blot, S. I., Hesse, U., Pattyn, P., De Hemptinne, B., et al. (2004). Perioperative factors determine outcome after surgery for severe acute pancreatitis. Critical Care December, 8(6). R504–R511. doi: 10.1186/cc2991
  7. Dong, Z., Petrov, M. S., Xu, J., Shanbhag, S., Windsor, J. A., & Pang, S. (2010). Peritoneal lavage for severe acute pancreatitis: A systematic review of randomised trials. World Journal of Surgery, 34(9), 2103–2108. doi: 10.1007/s00268-010-0665-3.
  8. Fernandes-Cruz, L., Margarona, E., & Llovera, J. (1993). Pancreatic ascites. Hepatogastroenterologyre, 40, 150–154.
  9. Foglio, E. J., & Gorelick, F. (2015). Abdominal paracentesis drainage: which patients with severe acute pancreatitis will benefit? Journal of clinical gastroenterology, 49(9), 717–719. doi: 10.1097/MCG.0000000000000387
  10. Freeman, M. L., Werner, J., Van Santvoort, H. C., Baron, T. H., Besselink, M. G., & Windsor, J. A. (2012). Interventions for necrotizing pancreatitis summary of a multidisciplinary consensus conference and an international multidisciplinary panel of speakers and moderators. Pancreas, 41(8), 1176–94. doi: 10.1097/MPA.0b013e318269c660
  11. Gutierrez, P. T., Folch-Puy, E., Bulbena, O., & Closa, D. (2008). Oxidised lipids present in ascitic fluid interfere with the regulation of the macrophages during acute pancreatitis, promoting an exacerbation of the inflammatory response. Gut, 57(5), 642–648. doi: 10.1136/gut.2007.127472
  12. Ihse, I., Evander, A., Gustafson, I., & Holmberg, J. T. (1986). Influence of peritoneal lavage on objective prognostic signs in acute pancreatitis. Annals of surgery, 204(2), 122–127. doi: 10.1097/00000658-198608000-00004
  13. Isaji, S., Takada, T., Mayumi, T., Yoshida, M., Wada, K., Yokoe, M., et al. (2015). Revised Japanese guidelines for the management of acute pancreatitis 2015: revised concepts and updated points. Journal of Hepato-Biliary-Pancreatic Sciences, 22(6), 433–445. doi: 10.1002/jhbp.260
  14. Li, Z., Xia, C., Zhang, L., Zhang, Y., Liu, Z., & Qiu, F. (2016). Peritoneal lavage for severe acute pancreatitis: a meta-analysis and systematic review. Pancreas, 45(6), 806–813. doi: 10.1097/MPA.0000000000000530
  15. Liu, L., Yan, H., Liu, W., Cui, J., Wang, T., Dai, R. et al. (2015). Abdominal paracentesis drainage does not increase infection in severe acute pancreatitis: a prospective study. Journal of Clinical Gastroenterology, 49(9), 757–763. doi: 10.1097/MCG.0000000000000358
  16. Lundberg, A. H., Eubanks, J. W., Henry, J., Sabek, O., Kotb, M., Gaber, L. et al. (2000). Trypsin stimulates production of cytokines from peritoneal macrophages in vitro and in vivo. Pancreas, 21(1), 41–51. doi: 10.1097/00006676-200007000-00050
  17. Mayer, A. D., McMahon, M. J., Corfield, A. P., Cooper, M. J., Williamson, R. C., Dickson, A. P., et al. (1985). Controlled clinical trial of peritoneal lavage for the treatment of severe acute pancreatitis. New England Journal of Medicine, 312(7), 399–404. doi: 10.1056/NEJM198502143120703
  18. Navalho, M., Pires, F., Duarte, A., Gonçalves, A., Alexandrino, P., & Távora, I. (2006). Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: Correlation with C-reactive protein values. Clinical Imaging, 30(2), 114–119. doi: 10.1016/j.clinimag.2005.09.026
  19. Rau, B., Bothe, A., & Beger, H. G. (2005). Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: Changing patient characteristics and outcome in a 19-year, single-center series. Surgery, 138(1), 28–39. doi: 10.1016 j.surg.2005.03.010
  20. Runyon, B. (1987). Amylase levels in ascitic fluid. J Clin Gastroenterol., 9(2), 171–174.
  21. Runzi, M., Niebel, W., Goebell, H., Gerken, G., & Layer, P. (2005). Severe acute pancreatitis: Nonsurgical treatment of infected necroses. Pancreas, 30(3), 195–199. doi: 10.1097/01.mpa.0000153613.17643.b3
  22. Segal, D., Mortele, K. J., Banks, P. A., & Silverman, S. G. (2007). Acute necrotizing pancreatitis: Role of CT-guided percutaneous catheter drainage. Abdominal Imaging, 32(3), 351–361. doi: 10.1007/s00261-007-9221-5
  23. Solanki, R., Thumma, V., Sastry, R. A., & Bheerappa, N. (2013). The role of image guided percutaneous drainage in multidisciplinary management of necrotizing pancreatitis. Tropical gastroenterology, 34(1), 25–30. doi: http://dx.doi.org/10.7869/tg.2012.87
  24. Sun, J., Li, W., Ni, H., Ke, L., Tong, Z., Li, N., & Li, J. (2013). A modified gastrointestinal failure score for patients with severe acute pancreatitis. Surgery Today, 43(5), 506–513. doi: 10.1007/s00595-013-0496-6
  25. Tang, J. C. F. (2017) Acute pancreatitis. Nejm. Retrieved from https: emedicine.medscape.com article 181364-treatment
  26. Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology Guideline: Management of Acute Pancreatitis. The American Journal of Gastroenterology, 108(9), 1400–1415. doi: 10.1038/ajg.2013.218
  27. Uchiyama, T., Yamamoto, T., Mizuta, E., & Suzuki, T. (1989). Pancreatic ascites - a collected review of 37 cases in Japan. Hepatogastroenterology, 36, 244.
  28. Wang, T., Liu, L., Luo, H., Dai, R., Liang, H., Chen, T., et al. (2016). Intra-abdominal pressure reduction after percutaneous catheter drainage is a protective factor for severe pancreatitis. Pancreas, 45(1), 127–133. doi: 10.1097/MPA.0000000000000420
  29. Watanabe, J., Kushihata, F., Honda, K., & Kobayashi, N. (2005). The usefulness of early laparoscopic surgery for determining a medical treatment plan in severe acute pancreatitis. Journal of Hepato-Biliary-Pancreatic Surgery, 12(5), 422–425. doi: 10.1007/s00534-005-1007-y
  30. Wig, J. D., Gupta, V., Kochhar, R., Doley, R. P., Yadav, T. D., & Poornachandra, K. S. (2010). The role of non-operative strategies in the management of severe acute pancreatitis. JOP : Journal of the pancreas, 11(6), 553–559.
  31. Wu, B. U., & Banks, P. A. (2013). Clinical management of patients with acute pancreatitis. Gastroenterology, 144(6), 1272–1281. doi: 10.1053/j.gastro.2013.01.075
  32. Xu, W., Schlagwein, N., Roos, A., van den Berg, T. K., Daha, M. R., & van Kooten, C. (2007). Human peritoneal macrophages show functional characteristics of M-CSF-driven anti-inflammatory type 2 macrophages. European Journal of Immunology, 37(6), 1594–1599. doi: 10.1002/eji.200737042
  33. Yang, C., Guanghua, F., Wei, Z., Zhong, J., Penghui, J., Xin, F., & Xiping, Z. (2010). Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis. Pancreas, 39(1), 16–19. doi: 10.1097/MPA.0b013e3181bab38b
  34. Yokoe, M., Takada, T., Mayumi, T., Yoshida, M., Isaji, S., Wada, K., et. al. (2015). Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. Journal of Hepato-Biliary-Pancreatic Sciences, 22(6), 405–432. doi: 10.1002/jhbp.259
  35. Zhu, L., Lu, J., Yang, J., & Sun, P. (2016). Early-phase peritoneal drainage and lavage in a rat model of severe acute pancreatitis. Surgery Today, 46(3), 371–378. doi: 10.1007/s00595-015-1172-9

Downloads

How to Cite

1.
Kasian VV, Cherkun OY, Sytnik DA, Sheiko VD. Surgical tactics with acute pancreatitis complicated ascites-peritonitis. Zaporozhye Medical Journal [Internet]. 2019Jul.15 [cited 2026May16];21(4). Available from: https://zmj.zsmu.edu.ua/article/view/173353

Issue

Vol. 21 No. 4 (2019)

Section

Review

License

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons